Predicting Lawsuits against Nursing Homes in the United States, 1997–2001


  • Christopher E. Johnson,

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    • Address correspondence to Christopher E. Johnson, Ph.D., Research Health Scientist, Rehabilitation Outcomes Research Center of Excellence, North Florida/South Georgia Veteran's Health System, 1601 SW Archer Rd., Gainesville, FL 32608-1197. He and Aram Dobalian, Ph.D., J.D., and Jeffrey Harman, Ph.D., are Assistant Professors, Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions, University of Florida, Gainesville. Janet Burkhard, M.B.A., is Director of Product Development, Health Grades, Inc., Lakewood, CO. Deborah K. Hedgecock is a Research Assistant, Florida Policy Exchange Center on Aging, University of South Florida, Tampa.

  • Aram Dobalian,

  • Janet Burkhard,

  • Deborah K. Hedgecock,

  • Jeffrey Harman


Objectives. To examine how nursing home characteristics impacted the number of lawsuits filed against the facilities in the United States during 1997–2001.

Data Sources/Study Setting. A stratified random sample of 2,378 nursing home in 45 states from 1997–2001. Data were obtained from Westlaw's Adverse Filings: Lawsuits database, the Centers for Medicare and Medicaid Services' (CMS) Online Survey, Certification, and Reporting (OSCAR) database, state complaint surveys, and through primary data.

Study Design. Negative binomial regression was used to explain total lawsuit variance by year. Explanatory variables included (a) facility characteristics—including staffing, number of beds, multistate system membership, for-profit ownership, (b) quality indicators—including total number and type of quality survey deficiencies, pressure sore development, and (c) market area—state has resident rights statutes, state complaint information. Resident acuity levels and year effects were controlled for.

Data Collection/Extraction Methods. Nursing homes were identified and linked to Westlaw data that was searched for the number of lawsuits filed against the home, and then linked to OSCAR data and a primary data analysis of multistate chain membership.

Principal Findings. Staffing levels for certified nursing assistants (CNAs) and registered nurses (RNs) and multistate chain membership were negatively related with higher numbers of lawsuits. More deficiencies on the licensing survey, larger, for-profit nursing homes, and being located in resident rights states were positively related with higher numbers of lawsuits.

Conclusion. This study suggests that nursing homes that meet long-stay staffing standards and minimum quality indicators, are nonprofit, smaller, and not located in resident rights states will experience fewer lawsuits.